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Organization
RIVERVIEW PHYSICAL THERAPY AND REHAB,LLC
Active
Organization
RIVERVIEW PHYSICAL THERAPY AND REHAB,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HARGOPAL TEKUMULLA PT (PHYSICAL THERAPIST)
(810) 966-9102
Entity
Organization
Contact information
Practice address
1702 WATER ST, PORT HURON, MI 48060-4136
(810) 966-9102
(810) 966-9104
Mailing address
1702 WATER ST, PORT HURON, MI 48060-4136
(810) 966-9102
(810) 966-9104
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501008202
MI
225X00000X
Occupational Therapist
5201003768
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080738
HAP OF MI
MI
01
—
164232
GREAT LAKES HEATH PLAN
MI
01
—
48102
HEALTH PLAN OF MICHIGAN
MI
05
—
4863011
—
MI
01
—
650G411130
BCBS OF MICHIGAN FOR PHYSICAL THERAPY
MI
01
—
670G411150
BCBS OF MICHIGAN FOR OCCUPATIONAL THERAPY
MI
01
—
P00311258
RAILROAD MEDICARE,PT
—
01
—
P00312642
RAILROAD MEDICARE ,OT,
—
Enumeration date
11/13/2007
Last updated
04/29/2008
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